Osteogenic Differentiation Capacity of Dental Pulp Stem Cells on 3D Printed Polyurethane/Boric Acid Scaffold

Additive manufacturing is growing in the area of dentistry and orthopedics due to the potential for the fabrication of individual implants. In this study, fused deposition modeling which is the most popular method was used to produce 3D scaffolds having a grid pattern from the polyurethane (PU) filament. Then, this scaffold was coated with boric acid (BA) with the thermionic vacuum arc technique. The microstructure analysis showed the macro-pores having a dimension of ~ 0.16 mm2. The BA coating increased the roughness in adverse decreased the wettability. The presence of BA on the scaffold before and after cell culture was confirmed by FESEM-EDS and ATR-FTIR. The Cell proliferation and osteogenic differentiation capacity of dental pulp stem cells (DPSCs) on uncoated and coated printed 3D PU scaffolds were also investigated. On the third day, cell viability was found to be higher (1.3-fold) in the groups containing BA. However, on the seventh day, the increase in cell proliferation in the PU+BA group was found to be less than in the other groups. According to Ca deposition analysis and Alizarin Red staining, PU+BA increased the calcium accumulation in the cells in both osteogenic induced and non-induced conditions at day 14. According to gene expression analysis, the Runx2 expression was not detected in PU+BA groups with and without differentiation medium (p ≤0.05). The expression of OCN was persistently increased up to 21-fold and 48-fold in cells on PU and PU+BA in osteogenic differentiation medium group after 14 days compared to control group (p ≤0.05). DSPP expression was observed only in PU+BA in osteogenic differentiation medium group. In line with the results that we have obtained, our 3D printed scaffolds have properties to trigger the differentiation of DPSCs cells in terms of osteogenicity.

The Effects of Grape Seed Oligomeric Proanthocyanidin and Nisin on Dental Pulp Stem Cells

Objective

This study aimed to evaluate the biological effects of "proanthocyanidin" (PA), and "nisin" (Ni), on dental pulp stem cells (DPSCs) and LPS-induced DPSCs as well as their antimicrobial effects against S. aureus and E. coli.

Materials and methods

After characterization of DPSCs, cytotoxicity of PA and Ni on DPSCs were evaluated using a water-soluble tetrazolium salt (WST-1). The cytokines and chemokines released by DPSCs and the expression levels of IL-6, IL-8, and TNF alpha were detected with human Cytokine Array C5 and enzyme-linked immunosorbent assay (ELİSA), respectively. The antibacterial activities of PA and Ni were tested using the drop plate method.

Results

PA at 75 μg/ml increased cell viability, decreased TNF-α expression of DPSCs, did not show any cytotoxic effects on LPS-induced DPSCs, and also showed a tendency to decrease TNF-α expression. PA at 75 μg/ml exhibited higher expressions of TIMP-2, OPG, IL-7, and IL-8 in LPS-induced DPSCs compared to DPSCs. Ni at 100 μg/ml decreased TNF-α expression in DPSCs with no cytotoxic effects. It provided increased cell viability and a downregulation trend of TNF-α expression in LPS-induced DPSCs. Both Ni and PA provided strong antibacterial effects against S. aureus. Ni at 200μg/ml had strong antibacterial effects against E. coli without affecting negatively the viability of both DPSCs and LPS-induced DPSCs and showed anti-inflammatory activity by decreasing TNF-α expression. PA provided strong antibacterial effects against E. coli at 200 μg/ml but affected DPSCs viability negatively.

Conclusion

PA and Ni at specific concentrations exhibited immunomodulatory activity on DPSCs and LPS-induced DPSCs without any cytotoxic effects and strong antibacterial effects on S. aureus.

Approaches to vital pulp therapies

Tooth decay, which leads to pulpal inflammation due to the pulp's response to bacterial components and byproducts is the most common infectious disease. The main goals of clinical management are to eliminate sources of infection, to facilitate healing by regulating inflammation indental tissue, and to replace lost tissues. A variety of novel approaches from tissue engineering based on stem cells, bioactive molecules, and extracellular matrix-like scaffold structures to therapeutic applications, or a combination of all these are present in the literature. Shortcomings of existing conventional materials for pulp capping and the novel approches aiming to preserve pulp vitality highligted the need for developing new targeted dental materials. This review looks at the novel approches for vital pulp treatments after briefly addresing the conventional vital pulp treatment as well as the regenerative and self defense capabilities of the pulp. A narrative review focusing on the current and future approaches for pulp preservation was performed after surveying the relevant papers on vital pulp therapies including pulp capping, pulpotomy, and potential approaches for facilitating dentin-pulp complex regeneration in PubMed, Medline, and Scopus databases.

Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial

BACKGROUND

The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical and radiographic performance of stainless-steel crowns (SSCs) and preformed zirconia crowns (ZCs).

METHODS

Forty-eight molar incisor hypomineralisation (MIH)- or caries-affected permanent molars in 20 healthy patients between 6-13-year-old were randomly divided into ZC and SSC groups (n = 24 teeth/group) in a split-mouth design. The oral hygiene levels of patients were assessed using Greene and Vermillion simplified oral hygiene index (OHI-S). Plaque accumulation and gingival health were evaluated using the Silness&Löe plaque index (PI) and Löe&Silness gingival index (GI), respectively. Clinical retention, marginal extension level, marginal adaptation of crowns and wear of the antagonist teeth were assessed at baseline, 1, 6, 12 and 18 months. The radiological assessments for evaluating the marginal adaptation of crowns and periapical pathology of crowned teeth were performed at 6 and 12 months. The data were analyzed using Kaplan-Meier analysis, Mann-Whitney U test, and two-way ANOVA.

RESULTS

A total of forty teeth in 17 children were evaluated for 18 months. ZCs had significantly lower gingival and plaque index values than teeth restored with SSCs during all evaluation periods (p < 0.05). Neither crown type resulted in clinically-detectable wear on opposing dentition or periapical pathology. One ZC was lost at 13 months, while all SSCs survived in function clinically. The cumulative survival rates of ZCs and SSCs were 95.2% and 100% respectively.

CONCLUSIONS

Both ZCs and SSCs showed high clinical retention rates in young permanent molars. ZCs had lower plaque accumulation and better gingival health than SSCs, which were consistently associated with mild gingival inflammation.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05049694.

Clinical Comparison of Preformed Zirconia and Composite Strip Crowns in Primary Maxillary Incisors: 18-Month Results of a Prospective, Randomized Trial

Purpose: The purpose of this study was to evaluate the clinical performance of composite strip crowns (SCs) and zirconia crowns (ZCs) on primary maxillary incisors affected by early childhood caries over 18 months. Methods: A total of 111 primary maxillary anterior teeth were included in 25 three-to five-year-old children. In each patient, the teeth were randomized to the SC and ZC groups (n equals 43 teeth/group) and sound teeth as the control group (n equals 25) in a split-mouth design. Patients' oral hygiene and clinical variables, including gingival health, plaque accumulation, pulpal health, secondary caries, retention, color match, and material loss, were assessed at baseline and at one, six, 12, and 18 months. Data were statistically analyzed using Fisher's exact test, the Friedman test, and the Kruskal-Wallis test. Results: Zirconia crowns had significantly lower plaque index values than strip crowns and controls during all recalls (P<0.05). The gingival index scores of both crowns improved after six months, while mild inflammation persisted in both groups due to increased exfoliation mobility. ZCs had better color match and retention (P<0.05) than SCs, with the latter being 100 percent for ZCs and 77.8 percent for SCs. Both crowns had similar and high pulp survival at 18 months (ZC equals 93.1 percent; SC equals 95.4 percent). Conclusions: Zirconia crowns had better clinical performance than composite strip crowns in terms of retention, restoration failure, and color change but similar gingival and pulpal health after 18 months. ZCs showed the lowest plaque accumulation when compared with sound teeth and SCs.

Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth with Pulp Necrosis: A Case Series

INTRODUCTION

In young individuals, deciduous tooth pulp might be utilized as a natural, biologic scaffold for the regenerative endodontic treatment (RET) of young permanent teeth with necrotic pulps and apical periodontitis. The present case series demonstrates the clinical and radiographic outcomes of a novel RET utilizing deciduous pulp autotransplantation in traumatized, necrotic young permanent incisors.

METHODS

Five previously-traumatized maxillary incisors of four 8-11,5-year-old patients were treated with a RET protocol that used 2.5% NaOCl irrigation and placement of calcium hydroxide dressing in the first visit. After 4 weeks, the intracanal medication was removed, and the whole pulp tissue harvested from the neighboring maxillary deciduous canine was transplanted into the disinfected root canal without induced apical bleeding. Following placement of an MTA coronal barrier, the access cavities were restored with acid-etch resin composite. The root canals of donor primary canines were filled with calcium hydroxide-iodoform paste and were restored as with the permanent incisors.

RESULTS

Three patients were followed-up for 24 months, and one patient for 12 months. All teeth demonstrated radiographic evidence of complete periapical healing, slight increase in dentinal wall thickness, and continued apical closure in the absence of clinical symptoms. A positive response to cold test was obtained in one incisor at 12 months and two at 24 months.

CONCLUSIONS

Based on 12- and 24-month clinical and radiographic findings, the present cases demonstrate a favorable outcome of a regenerative endodontic treatment protocol utilizing deciduous pulp autotransplantation in young permanent incisors with pulp necrosis.

The quality of root canal treatment and periapical status of permanent teeth in Turkish children and teens: a retrospective CBCT study

OBJECTIVE

This study aimed to assess the quality of root canal fillings and the prevalence of periapical radiolucencies in the permanent teeth of 6-18 year-old Turkish children.

METHODS

CBCT images of 150 patients' 235 teeth with a mean age of 16.0 ± 2.06 years were included. Root development stage, quality of root canal filling, the presence and severity of periapical radiolucencies, and their relationship with anatomical structures were recorded. Correlations between the quality of root canal filling, periapical lesion, and lesion size were assessed using regression analyses.

RESULTS

A total of 235 teeth (528 root canals) were evaluated. 65.5% of root canals had periapical lesions. Immature roots and mandibular teeth had the highest prevalence and the largest size of periapical radiolucencies (p < 0.05). Overfilling (n = 52), underfilling (n = 93), unfilled (n = 46), inhomogeneously filled (n = 113) root canals and poor coronal restoration (n = 85 teeth) were observed in terms of technical failures of endodontic treatment. The quality of endodontic treatment was associated with the presence of periapical lesion and lesion size (p < 0.05). Teeth with under-filled, overfilled or inhomogeneously filled root canals and poor coronal restoration had a periapical lesion larger than 5 mm (p < 0.05). Immature teeth were most associated with the presence of lesion (OR = 4.07) and the lesion size > 5 mm (OR = 3.71).

CONCLUSION

The prevalence of periapical radiolucencies in young permanent teeth showed an increase when the tooth was an incisor, had incomplete root development, or the root filling had technical errors.

Oral health status of children and young adults with maple syrup urine disease in Turkey

Background

Maple syrup urine disease (MSUD) is an inherited disorder clinically characterized by ketoacidosis, seizures, coma, psychomotor delay, and intellectual disability. The treatment requires a life-long protein-restricted diet, rich in carbohydrates and fats, supplemented with a medical amino acid formula. Diet, oral health and general health influence each other in a vicious cycle. The aim of this study was to investigate the oral health status of children and young adults with MSUD in Turkey.

Methods

A descriptive study was conducted on patients with MSUD who applied for routine follow-up to the pediatric metabolic diseases clinic at Hacettepe University, Children's Hospital in Ankara, Turkey in a 12-month period. Patients with any other concomitant genetic diseases and acute infection were excluded. A total of twenty-five patients were enrolled and underwent oral examination including DMFT/S, dmft/s (decayed/missing/filled teeth/surfaces for deciduous and primary teeth, respectively), plaque and gingival indices. Panoramic radiographs were obtained in 12 cooperative patients.

Results

Mean age was 9.88 ± 5.68 s.d years. More than half of the parents had only primary school level education, and low income. Fourteen patients consumed medical formula during or right before sleep. Fourteen patients reported caries-associated pain. Gingival inflammation was present in all 15 patients who cooperated for evaluation. Seven out of twelve patients had at least one dental anomaly or alterations in mandibular morphology. Five patients had previously been treated for caries under general anesthesia. To our knowledge, this is the first study to document oral clinical and radiologic findings in patients with MSUD.

Conclusions

Impaired oral health was observed in this rare disease population. Regular dental referral by physicians, preventive measures and dental treatments should be included in multidisciplinary management of maple syrup urine disease to promote oral health.

Oral health status of children with phenylketonuria

Background Diet plays an integral role in the maintenance of oral health, but dietary modifications due to medical problems such as phenylketonuria (PKU) can have adverse effects on oral health. This descriptive study was performed to evaluate the oral health status of children with PKU. Methods One hundred and ninety-seven patients with PKU aged between 1 and 22 years were evaluated. Clinical evaluations were performed by one experienced dentist regarding dental caries, gingival health and dental erosion. Categorical variables were assessed with descriptive statistics. Differences in feeding frequencies and sociodemographic characteristics were compared regarding dental caries using chi-square (χ2) tests. Results One hundred and thirty-two patients (67%) had dental caries. The mean plaque index (PI) and gingival index (GI) values were 1.37 ± 0.58 and 1.40 ± 0.64, respectively, which shows moderate plaque accumulation and moderate gingival inflammation. Of the patients, 85.3% did not brush their teeth regularly and 90.4% had never visited a dentist before. No statistically significant differences were found in dental caries according to feeding frequencies (p = 0.448). Conclusions Despite the high prevalence of caries in patients with PKU, most had never seen a dentist. Physicians must encourage patients with PKU and their parents to have regular dental visits to maintain an optimal general and oral health.

Oral health status of children with mouth breathing due to adenotonsillar hypertrophy

OBJECTIVES

Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January-July 2015.

METHODS

The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05.

RESULTS

Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ± 2.6. Mean dmft was 3.8 ± 3.6, dmfs 9.7 ± 1.1, DMFT 0.4 ± 1.0 and DMFS 0.6 ± 1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p < 0,001).

CONCLUSIONS

The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.